What are the Risk Factors for Kidney Cancer? and Warning Signs of Kidney Cancer ?

Risk Factors for Kidney Cancer

Some people's particular habits, activities, lifestyles, or genetics make them more susceptible to certain forms of cancer. Several risk factors, below, have been identified as increasing the risk of developing kidney cancer.

Smoking and Kidney Cancer:
Cigarette smoking has been shown to double the risk of kidney cancer and contributes to as many as one-third of the cases.

Obesity, Diet and Kidney Cancer:
Obesity and a high fat diet raises the risk of kidney cancer, according to some studies.

Workplace Exposure and Kidney Cancer:
Exposure in the workplace to chemicals including petroleum products, heavy metals, cadmium (in batteries, paints, or welding materials), or asbestos can increase the risk of kidney cancer.

Certain Genes and Kidney Cancer:
Changes in certain genes (either inherited or affected by environmental factors) can increase the risk of developing kidney tumors.

Certain Disorders and Kidney Cancer:
People with disorders such as von Hippel Lindau (VHL) syndrome caused by an inherited gene mutation; polycystic disorders affecting the kidneys, liver or pancreas; or those on long-term dialysis, are at an increased risk for developing kidney cancer.

Warning Signs of Kidney Cancer

Because routine imaging tests are now relatively common in the U.S., most people with kidney cancer never experience any symptoms and are diagnosed with the disease at an early stage. If symptoms do develop, the most common one is blood in the urine. Other symptoms include: lower back pain that does not go away; a lump in the abdomen; fatigue; loss of appetite and rapid weight loss for no apparent reason; fever unrelated to a cold, flu, or other infection; swollen ankles and legs; high blood pressure; low red blood cell counts (anemia).

It is important to report any of these symptoms to your physician since kidney cancer that is found and treated early can have a higher survival rate.

Diagnosis

Patients of kidney cancer need a complete staging work up to plan the line of management. Quite often it is a multidisciplinary approach which gives best results for an individual patient. It needs good physical examination along with complete blood tests like haemogram, blood chemistry, radiological imaging like ultrasound, CT scan, and MRI scan. Histological diagnosis is to be confirmed

by FNAC/trucut biopsy.

 In the early stage (localised kidney tumour, not spread to distant organs in the body), it is managed better with radical surgery, which is curative in majority of patients.

Radiation is one more modality of treatment that is advised in a very selective group of patients.

 Kidney cancer (RCC) is considered as one of the radio resistant and chemoresistant cancers with very poor response. For advanced stage RCC, biologic therapy/immunotherapy (like Interferon/ Interleukin-2) along with chemotherapy had been used for a long time with limited benefit.

Treatment

Surgery is the main treatment for kidney cancer that hasn’t spread outside the kidney (stages 1 and 2). If the tumour is small, the surgeon will usually only remove the part of the kidney containing the tumour. But in some cases, depending on the size of the cancer, the whole kidney may need to be removed (nephrectomy). This is sometimes done using keyhole surgery.

In some situations, treatments that destroy the cancer cells using heat (radiofrequency ablation) or extreme cold (cryotherapy) can be used to treat small kidney cancers instead of an operation. There is currently no standard treatment given to reduce the risk of kidney cancer coming back after surgery (called adjuvant treatment).

Advanced Cancer

Even when the cancer has spread outside the kidney, your surgeon may still advise you to have an operation to remove the kidney. This can help to slow down and control the cancer. You’ll usually have treatment with a targeted therapy drug as well.

When kidney cancer has spread outside the kidney and to other parts of the body the main treatment is targeted therapy. Occasionally radiotherapy, chemotherapy orhormonal therapy treatment is used.

Kidney Cancer Treatment and Diagnosis in India

Treatment and Diagnosis:

If a patient has symptoms that suggest kidney cancer, the doctor may perform one or more of the following procedures:

• Physical exam: The doctor checks general signs of health and tests for fever and high blood pressure. The doctor also feels the abdomen and side for tumors.
• Urine tests: Urine is checked for blood and other signs of disease.
• Blood tests: The lab checks the blood to see how well the kidneys are working. The lab may check the level of several substances, such as creatinine. A high level of creatinine may mean the kidneys are not doing their job.
• Intravenous pyelogram (IVP): The doctor injects dye into a vein in the arm. The dye travels through the body and collects in the kidneys. The dye makes them show up on x-rays. A series of x-rays then tracks the dye as it moves through the kidneys to the ureters and bladder. The x-rays can show a kidney tumor or other problems.
• CT scan (CAT scan): An x-ray machine linked to a computer takes a series of detailed pictures of the kidneys. The patient may receive an injection of dye so the kidneys show up clearly in the pictures. A CT scan can show a kidney tumor.
• Ultrasound test: The ultrasound device uses sound waves that people cannot hear. The waves bounce off the kidneys, and a computer uses the echoes to create a picture called a sonogram. A solid tumor or cyst shows up on a sonogram.
• Biopsy: In some cases, the doctor may do a biopsy. A biopsy is the removal of tissue to look for cancer cells. The doctor inserts a thin needle through the skin into the kidney to remove a small amount of tissue. The doctor may use ultrasound or x-rays to guide the needle. A pathologist uses a microscope to look for cancer cells in the tissue.
• Surgery: In most cases, based on the results of the CT scan, ultrasound, and x-rays, the doctor has enough information to recommend surgery to remove part or the entire kidney. A pathologist makes the final diagnosis by examining the tissue under a microscope.

Staging

To plan the best treatment, the doctor needs to know the stage (extent) of the disease. The stage is based on the size of the tumor, whether the cancer has spread and, if so, to what parts of the body.

Staging may involve imaging tests such as an ultrasound or a CT scan. The doctor also may use an MRI. For this test, a powerful magnet linked to a computer makes detailed pictures of organs and blood vessels.

Doctors describe kidney cancer by the following stages:

• Stage I is an early stage of kidney cancer. The tumor measures up to 2 3/4 inches (7 centimeters). It is no bigger than a tennis ball. The cancer cells are found only in the kidney.
• Stage II is also an early stage of kidney cancer, but the tumor measures more than 2 3/4 inches. The cancer cells are found only in the kidney.
• Stage III is one of the following:
• The tumor does not extend beyond the kidney, but cancer cells have spread through the lymphatic system to one nearby lymph node; or
• The tumor has invaded the adrenal gland or the layers of fat and fibrous tissue that surround the kidney, but cancer cells have not spread beyond the fibrous tissue. Cancer cells may be found in one nearby lymph node; or
• The cancer cells have spread from the kidney to a nearby large blood vessel. Cancer cells may be found in one nearby lymph node.
• Stage IV is one of the following:
• The tumor extends beyond the fibrous tissue that surrounds the kidney; or
• Cancer cells are found in more than one nearby lymph node; or
• The cancer has spread to other places in the body such as the lungs.
• Recurrent cancer is cancer that has come back (recurred) after treatment. It may come back in the kidney or in another part of the body.

Surgery

Surgery is the most common treatment for kidney cancer. It is a type of local therapy. It treats cancer in the kidney and the area close to the tumor.

An operation to remove the kidney is called a nephrectomy. There are several types of nephrectomies. The type depends mainly on the stage of the tumor. The doctor can explain each operation and discuss which is most suitable for the patient:

• Radical nephrectomy: Kidney cancer is usually treated with radical nephrectomy. The surgeon removes the entire kidney along with the adrenal gland and some tissue around the kidney. Some lymph nodes in the area also may be removed.
• Simple nephrectomy: The surgeon removes only the kidney. Some people with Stage I kidney cancer may have a simple nephrectomy.
• Partial nephrectomy: The surgeon removes only the part of the kidney that contains the tumor. This type of surgery may be used when the person has only one kidney, or when the cancer affects both kidneys. Also, a person with a small kidney tumor (less than 4 centimeters) may have this type of surgery.

Arterial embolization

Arterial embolization is a type of local therapy that shrinks the tumor. Sometimes it is done before an operation to make surgery easier. When surgery is not possible, embolization may be used to help relieve the symptoms of kidney cancer.

Radiation therapy

Radiation therapy (also called radiotherapy) is another type of local therapy. It uses high-energy rays to kill cancer cells. It affects cancer cells only in the treated area. A large machine directs radiation at the body. The patient has treatment at the hospital or clinic, 5 days a week for several weeks.

A small number of patients have radiation therapy before surgery to shrink the tumor. Some have it after surgery to kill cancer cells that may remain in the area. People who cannot have surgery may have radiation therapy to relieve pain and other problems caused by the cancer.

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What is kidney cancer? : Kidney cancer is more common in people over 60

Kidney cancer is more common in people over 60 and rarely affects people under 40. Usually only one kidney is affected, and it’s rare for cancer to affect the other kidney.

Wilms’ tumour (or nephroblastoma) is an uncommon type of kidney cancer that can affect very young children. 

Cancer of the kidney isn’t infectious and can’t be passed on to other people.

There are different types of kidney cancer. About 90% of kidney cancers (9 out of 10) are renal cell cancers (RCC), sometimes called renal adenocarcinoma. They start in the cells that line very small tubes, called tubules, in the kidney cortex.

There are different types of renal cell cancer. The most common type is clear cell renal cancer. Less common types are papillary, chromophobe and collecting duct renal cancer.

Another type of cancer that can affect the kidneys starts in the cells that line the renal pelvis, where the kidney joins with the ureter. These cancers, sometimes called transitional cell cancers, behave and are treated differently to renal cell cancer.  This section is about renal cell cancer, which we call kidney cancer.

Kidney cancer comprises of three per cent of all cancers. The most common subtype is renal cell carcinoma. It is more commonly seen in USA than India. It is a slow growing cancer in majority of cases, but it behaves aggressively in some patients.

Causes

• The cause of kidney cancer is still unclear.
• However it is associated with certain environmental risk factors like smoking, exposure to cadmium, asbestos etc.
• It is seen to have hereditary/ genetic predisposition.
• It is more common in males, in older people between the ages of 60 and 70, and in individuals with lack of exercise and obesity.

Symptoms

• Clinical symptoms are mostly related to primary tumour i.e. haematuria (blood in urine), flank pain, and mass in abdomen.
• Some patients have weight loss unexplained fever, and features of hypercalcaemia (high calcium level in blood).
• In advanced stage disease patients may complain of pain in the bones, backache due to bone metastasis, cough/ breathing difficulty because of lung spread.
• Rarely, symptoms may include headache, vomiting, paralysislfits, and brain metastasis. Anaemia and fatigue may be symptoms in some cases.

Diagnosis

Patients of kidney cancer need a complete staging work up to plan the line of management. Quite often it is a multidisciplinary approach which gives best results for an individual patient. It needs good physical examination along with complete blood tests like haemogram, blood chemistry, radiological imaging like ultrasound, CT scan, and MRI scan. Histological diagnosis is to be confirmed

by FNAC/trucut biopsy.

 In the early stage (localised kidney tumour, not spread to distant organs in the body), it is managed better with radical surgery, which is curative in majority of patients.

Radiation is one more modality of treatment that is advised in a very selective group of patients.

 Kidney cancer (RCC) is considered as one of the radio resistant and chemoresistant cancers with very poor response. For advanced stage RCC, biologic therapy/immunotherapy (like Interferon/ Interleukin-2) along with chemotherapy had been used for a long time with limited benefit.

Treatment

Surgery is the main treatment for kidney cancer that hasn’t spread outside the kidney (stages 1 and 2). If the tumour is small, the surgeon will usually only remove the part of the kidney containing the tumour. But in some cases, depending on the size of the cancer, the whole kidney may need to be removed (nephrectomy). This is sometimes done using keyhole surgery.

In some situations, treatments that destroy the cancer cells using heat (radiofrequency ablation) or extreme cold (cryotherapy) can be used to treat small kidney cancers instead of an operation. There is currently no standard treatment given to reduce the risk of kidney cancer coming back after surgery (called adjuvant treatment).

Advanced Cancer

Even when the cancer has spread outside the kidney, your surgeon may still advise you to have an operation to remove the kidney. This can help to slow down and control the cancer. You’ll usually have treatment with a targeted therapy drug as well.

When kidney cancer has spread outside the kidney and to other parts of the body the main treatment is targeted therapy. Occasionally radiotherapy, chemotherapy orhormonal therapy treatment is used.

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